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Knowledge is power

I received a forwarded e-mail this week from a family member that I initially treated like so many forwarded e-mails. I found it interesting but perhaps dubious.

The message, which purportedly originated with two U.S. Department of Commerce budget analysts, said the following:

“Since the cost of prescription drugs is so outrageous, I thought everyone I knew should know about this. Please read the following and pass it on.

“It pays to shop around. This helps to solve the mystery as to why they can afford to put a Walgreens on every corner. On Monday night, Steve Wilson, an investigative reporter for Channel 7 News in Detroit, did a story on generic drug price gouging by pharmacies. He found in his investigation, that some of these generic drugs were marked up as much as 3,000% or more. Yes, that’s not a typo … three thousand percent! So often, we blame the drug companies for the high cost of drugs, and usually rightfully so. But in this case, the fault clearly lies with the pharmacies themselves For example, if you had to buy a prescription drug, and bought the name brand, you might pay $100 for 100 pills. The pharmacist might tell you that if you get the generic equivalent, they would only cost $80, making you think you are ‘saving’ $20. What the pharmacist is not telling you is that those 100 generic pills may have only cost him $10!

“At the end of the report, one of the anchors asked Mr. Wilson whether or not there were any pharmacies that did not adhere to this practice, and he said that Costco, Sam’s Club and other discount volume stores consistently charged little over their cost for the generic drugs. I went to the discount store’s website, where you can look up any drug, and get its online price. It says that the in-store prices are consistent with the online prices. I was appalled. Just to give you one example from my own experience, I had to use the drug, Comparing, which helps prevent nausea in chemo patients. I used the generic equivalent, which cost $54.99 for 60 pills at CVS. I checked the price at Costco, and I could have bought 100 pills for $19.89. For 145 of my pain pills, I paid $72.57. I could have got 150 at another discount store for $28.08. I would like to mention, that although these are a ‘membership’ type store, you do NOT have to be a member to buy prescriptions there, as it is a federally regulated substance. You just tell them at the door that you wish to use the pharmacy, and they will let you in.”

The e-mail goes on to list retail markups of various drugs from the cost of active ingredients to the consumer price, saying, for example, that the consumer price for 100 20mg tablets of Prozac (fluoxetine) is $247.47, even though the “general active ingredients” for that quantity cost a mere 11 cents. That translates to a markup of an astounding 224,973 percent.

For Xanax (alprazolam), the alleged markup for 100 tablets of the 1mg variety was 569,958 percent.

Being the good investigative reporter that I sometimes try to be, I checked it out. I don’t know where to find the information on basic active ingredients, but it’s easy enough to compare the retail prices of generic and name-brand drugs at two chain stores. lists the price of name-brand Xanax 1 mg at $318.18 for 180 tablets, or $1.77 per pill. The same dosage and quantity of generic alprazolam is $38.79, or 21.5 cents per pill.

Prozac 20mg in a quantity of 90 is priced at $374.89 ($4.17 each), while 90 generic 20mg fluoxetine capsules go for $53.89, or about 60 cents each, at the Walgreens Web site.

At, 100 tablets of 1mg Xanax will set you back $155.59. That’s $1.56 per pill, a little bit less than at Walgreens. However, the generic alprazolam 1mg is just $15.69, or 15.7 cents each, for a 27 percent savings over the Walgreens price.

For 20mg of Prozac, Costco charges $381.69 for a quantity of 100, or $3.82 per dosage. But 100 fluoxetine 20mg capsules cost a mere $11.29, or 11.3 cents each. That is more than 80 percent below the Walgreens price.

There you have it, more proof what a powerful consumer tool the Internet is. Health information, what a wonderful thing.

June 23, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Illinois to post ambulatory surgery rates online

My home state, Illinois, is joining the growing list of states posting costs of various elective medical procedures online.

This week, Gov. Rod Blagojevich signed a bill that will require ambulatory surgery centers and hospital outpatient facilities by 2007 to report how often they perform 30 specific procedures and what they charge for each service. The Illinois Department of Public Health will post the data on its Web site.

The law states that department must collect the data from “claims and encounter data according to uniform electronic data element formats as required under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).”

Could it be that someone actually is taking the HIPAA transaction regulations seriously?

Read the press release on the Illinois law from the governor’s office here.

Read the Chicago Tribune’s story here (but hurry, because these stories don’t stay free for more than a week unless you subscribe to the print edition).

June 15, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.


I’m back from a whirlwind tour of the Northeast, full of planes (into DCA, out of BWI), trains (subways in Chicago, NYC and DC, plus Maryland commuter rail), automobiles (a long stretch of I-95) and high-ranking HHS officials.

In addition to a family party north of New York City, I hit the HIMSS, NAHIT and AHRQ conferences in New York and Washington last week. (If you don’t know what the acronyms mean, click the links.)

A lot of what I saw I reported for Health-IT World News and on an earlier post on this blog, so I won’t repeat. But here are a few more random notes:

  • Brent James, M.D., executive director of the Institute for Health Care Delivery Research at Intermountain Health Care in Salt Lake City, called HHS Secretary Mike Leavitt a “techno-geek.” Leavitt proudly accepted this designation. I suppose that can’t be a bad thing for health IT.

    Leavitt mentioned that he has had a health savings account since January. Of course, he is privy to the supposedly excellent health benefits offered to federal employees, so he’s just trying to drum up support for HSAs and other “consumer-driven” options. The jury remains out.

  • Despite the supposed bipartisan support for pending health IT legislation, a panel of congressional staffers at the AHRQ meeting highlighted some important differences of opinion, even within parties. For example, an aide to Sen. Judd Gregg (R-N.H.) noted that the government is moving more slowly than the private sector in terms of promoting health IT adoption. He said, “One of the most important things we can do is not get in the way.”

    One audience member challenged this strategy because Medicare payment incentives are not aligned with the goal of increasing the usage of clinical IT and improving the quality of care. This person did not identify party affiliation, but a Republican staffer on the House Ways and Means Committee insisted that government should focus on where it has the “most leverage,” namely Medicare.

    Later, HHS national health IT coordinator David Brailer, M.D., said, “My advice is do not wait for the federal government. Our job is to catch up with you.”

    Brailer also said that government officials are still shooting for Aug. 1 release date for VistA Office EHR, an ambulatory version of the Department of Veterans Affairs‘ open-source EHR.

  • Former House Speaker Newt Gingrich said that it was pretty much impossible to write one bill to cure what ails something that accounts for 15 percent of gross national product, namely healthcare. He said that Sen. Hillary Clinton (D-N.Y.) agrees. However, he voiced his strong support for the Kennedy-Murphy bill in the House. “It’s not a perfect bill, but it’s a very important step in the right direction,” Gingrich said.

  • The Medical Group Management Association received more than 3,500 responses on the use of health IT in physician practices and is preparing a report for publication in Health Affairs. The only hint of the results I got is that, while cost remains the No. 1 factor in IT purchasing decisions, others are gaining in importance.

  • By next year, UnitedHealthcare is planning on having personal health records embedded in the eligibility and payment cards it distributes to members, according to Senior Vice President Reed Tuckson, M.D.

June 12, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Chasing the secretary and other tales of two cities

WASHINGTON—Health and Human Services Secretary Mike Leavitt must have thought I was stalking him when I, along with a few other reporters, followed him toward the door after his speech at the Washington Convention Center on Wednesday.

He, as did I, noticed that it was the third day in a row I had heard him give essentially the same speech—at three different venues in two cities.

Monday, I saw him at the Health Information and Management Systems Society summer meeting at the New York Marriott Marquis Hotel, right on Times Square.

About 24 hours and a 250-mile road trip with Mom and Dad later (they live in suburban Maryland), I was at the Wyndham City Center Hotel at New Hampshire Avenue and M Street in Northwest Washington. There, addressing the annual meeting of the National Alliance for Health Information Technology, was the very same HHS secretary, one Michael O. Leavitt.

Wednesday, the scene shifted a couple of miles east to the Agency for Healthcare Research and Quality’s overlapping health IT and patient safety conferences, the combination of which is most welcome and long overdue.

Podium: Leavitt. Press corps: Versel. Topics: the soon-to-be chartered American Health Information Community and the HHS requests for proposal on how to create a national, interoperable health IT infrastructure. Analogies used in the speech: Gears in a grandfather clock and standardized rail gauges. Déjà vu: All over again.

Just for good measure, AHRQ director Carolyn Clancy, M.D., and national health IT coordinator David Brailer, M.D., also were present Monday and Wednesday. On Tuesday, I got a little variety with a “town hall” session led by Reps. Patrick Kennedy (D-R.I.) and Tim Murphy (R-Pa.), co-sponsors of a bill to promote electronic connectivity in healthcare.

I also scored about five minutes of quality time with former House Speaker Newt Gingrich, whom I was told was going to hold a press conference following his early-morning speech at HIMSS in New York. When I got to the press room, there was no press conference, just Newt and an aide eating breakfast. He invited me to sit down and chat for a bit.

My impression is that he’s a lot smarter than some people have made him out to be over the years and that he certainly has mellowed from his days as the bombastic leader of the 1994 Republican Revolution.

Just how much has he mellowed? Everyone knows about Gingrich playing nice with Sen. Hillary Clinton (D-N.Y) in the name of promoting health IT, but he shared a story during his speech about how a healthcare “debate” someone wanted to stage between Gingrich and Democratic National Committee chief Howard Dean, M.D., in Iowa became a rather cordial “dialog.” Apparently it didn’t get a whole lot of news coverage. This is all I could find.

For the record, Hillary also is playing nice with Senate Majority Leader Bill Frist, M.D. (R-Tenn.), who doesn’t exactly qualify as a Friend of Bill, Chelsea or any other Clinton. She and Frist are preparing a Senate companion to the Kennedy-Murphy bill.

As they say, politics makes strange bedfellows—though maybe it’s not surprising, given that healthcare costs are pretty much out of control, quality of care is sub-optimal and 45 million Americans lack any sort of insurance coverage.

That number could become 45,000,001 on July 1, when my COBRA benefits run out. I still have not found a suitable plan for myself. Perhaps it’s time for a quickie wedding just for the health insurance. Any takers?

June 9, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Update on Bill Yasnoff

A couple of weeks ago, I speculated that Dr. Bill Yasnoff might be sent as Dr. David Brailer’s replacement when Brailer had to cancel his scheduled appearance at the TEPR conference in Salt Lake City. Soon after posting that thought here, I was informed that Yasnoff had left his position as coordinator of the National Health Information Infrastructure project within the Department of Health and Human Services.

I now know where Yasnoff is: He has started his own consulting firm, NHII Advisors, to help those working on healthcare IT infrastructure systems and projects. The firm is based in Arlington, Va. A Web site,, is not yet functional, though that’s the domain for Yasnoff’s e-mail address.

As a matter of courtesy, I’m hesitant to publish his e-mail and phone number here, but let’s just say he’s in the phone book.

One more note: I’m expecting to surpass 2,000 visitors to this site since I started tracking hits last September. Thanks for reading and thanks for your feedback on my blog. As volume increases, I may stick some Google ads on the page if I can do so in an unobtrusive way, in hopes of raking in the massive sum of a few pennies a week.

June 2, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.